Large Salmonella Enteritidis outbreak with prolonged transmission attributed to an infected food handler, Texas, 2002.

In March 2002, an outbreak of Salmonella Enteritidis (SE) infections occurred at a convention centre in Dallas, Texas and continued for 6 weeks. We conducted epidemiological studies, obtained clinical and environmental cultures, and interviewed employees to identify risk factors for infection. From 17 March-25 April 2002, the implicated hotel kitchen catered 41 multi-day conferences attended by 9790 persons. We received 617 illness reports from residents of 46 states. Sauces or items served with sauces were implicated in three cohort studies. SE phage-type 8 was identified as the agent. Eleven food service employees, including one who prepared sauces and salsa, had stool cultures that yielded SE. Although the original source was not determined, prolonged transmission resulted in the largest food handler-associated outbreak reported to date, affecting persons from 46 US states. Transmission ended with implementation of policies to screen food handlers and exclude those whose stool cultures yielded salmonellas.

Approaches to contact investigations in Texas.

Tuberculosis (TB) spreads when family and social contacts breathe the air exhaled by someone with active TB disease. Contact investigation is the most appropriate strategy to interrupt the transmission and subsequent development of TB. One of the problems associated with contact investigations in an area with a very diverse population has been the inability of investigations to adapt their methods of approach to the different circumstances of each person with TB disease. Through interviews and group discussions with public health field workers and local TB program managers across Texas, the authors have been able to gather information on how contact investigation practices can be customized to overcome barriers specific to different populations in the state and generate a productive outcome. Variables such as culture, language, risk factors, and various settings may require a different investigational approach than the standard, traditional approach to contact investigation. It is anticipated that the concept of customizing contact investigations to meet the needs of specific populations and circumstances will become the practice worldwide, and will be a useful tool in the management of contact investigations.